Post thrombotic syndrome after thrombotic venous thoracic outlet syndrome.

Authors

Samy Benhalima, Giovanni Gautier, Frédéric Douane, Alban Fouasson-Chailloux, Guillaume Gadbled, Benjamin Espinasse, Blandine Maurel, Marie Morard, Olivier Espitia

Published in

Journal of vascular surgery. Venous and lymphatic disorders. Pages 102639. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

Thrombotic venous thoracic outlet syndrome (T-vTOS) including Paget-Schrotter syndrom is a rare form of upper extremity deep vein thrombosis (UEDVT) that mainly affects young, active individuals. Its optimal management remains debated and medium-term outcomes are poorly documented.
Consecutive patients from the vascular medicine department of a university hospital with T-vTOS between 2014 and 2024 were included in a retrospective study. Patients were stratified according to the presence of post-thrombotic syndrome with the modified Villalta score at last follow-up (<5 vs ≥5). Clinical characteristics, therapeutic strategies and outcomes were systematically assessed through a standardized consultation performed by the same physician. Univariable and multivariable logistic regression analyses, using Firth's penalized-likelihood method to account for the limited number of events, were performed to identify factors associated with post-thrombotic syndrome.
Fifty patients were included: 28 with a Villalta score <5 and 22 with a Villalta score ≥5 at last follow-up. Patients with Villalta <5 achieved higher rates of complete subclavian vein recanalization at follow-up (63% vs 32%, p=0.045) and were less likely to have persistent subclavian vein occlusion (26% vs 59%, p=0.023). Villalta ≥ 5 patients more often required prolonged anticoagulation (73% vs 29%, p=0.004) and more frequently underwent acute-phase endovascular treatment (36% vs 4%, p=0.007). In multivariable analysis endovascular treatment alone without thoracic outlet surgery was associated with PTS (OR 10.6, 95% CI 1.15; 98.09) (p=0.037), whereas there was no association between PTS and patients who had undergone both endovascular treatment and TOS surgery: OR 1.3 (95% CI 0.26; 6.87) (p=0.736).
This study highlights the central role of venous patency in the clinical course of T-vTOS, with persistent subclavian vein occlusion associated with post-thrombotic syndrome. The association observed between acute-phase endovascular treatment alone and post-thrombotic syndrome does not support a clear benefit of this strategy. However, endovascular therapy in conjunction with surgical decompression of the thoracic outlet may reduce the risk of post-thrombotic syndrome.

PMID:
42855073
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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